Success of a Simplified Hepatitis C Virus Screening and Treatment Program in a Low-to-Middle Income Country

A simplified, decentralized hepatitis C virus (HCV) care center in a low-to-middle-income country was able to maintain high patient retention and treatment efficacy. These findings, from a pilot program, were published in Lancet Gastroenterology and Hepatology.

This program was launched by the Médecins Sans Frontières in 2018 in the health operational district of Moung Russei of Cambodia, which consist of 13 health centers caring for 213,392 individuals living in 175 villages. This program featured training about HCV for staff and serology testing via a rapid diagnostic test from capillary blood. Patients positive for HCV were assessed for viral load by a general physician, and had a minimal treatment evaluation at the district referral hospital. In appropriate cases, patients were given 400 mg oral sofosbuvir and 60 mg daclatasvir daily for 12 or 24 weeks.

A total of 10,425 individuals were screened for HCV at a screening rate of 1.9% to 26.2% of the population of the surrounding area for each rural health center. The screened individuals were aged median 44 years (interquartile range [IQR], 31-55 years) and 61.9% were women.

HCV infections were detected among 778 (7.5%) patients. Patients with HCV were significantly older (58 vs 40 years; P <.0001) than those with negative HCV antibody tests. Of those positive for HCV, 71.0% were viremic. The median time from positive antibody test to viral load assessment was 1 weekday (IQR, 0-10 days).

Among the patients who were viremic, 98.7% were assessed at the HCV clinic, and 99.4% of those patients initiated treatment. The time from diagnosis to treatment was median 5 weekdays (IQR, 3-8 days).

Most patients (91.5%) were determined to have a simple HCV case. Patients with a simple case were significantly younger (P =.0074) and fewer had cirrhosis (P <.0001), but simple cases were associated with higher viral load (³1,000,000 IU/mL; P =.0026).

Treatment was completed by 97.2% of patients. Those who did not complete treatment had died (n=4), had an adverse event (n=2), or were lost to follow-up (n=9).

Adverse events included fatigue (n=1) and upset stomach (n=1). The 5 serious adverse events were determined to not be associated with HCV treatment (infection, n=2; cardiovascular disease, n=1; panic attack, n=1; missing data, n=1).

At 12 weeks, 95.4% of patients (95% CI, 93.2%-97.1%) had sustained virological response. The patients with complicated cases had a lower response rate (85.3%; 95% CI, 68.9%-95.0%).

The success of this pilot program would not have been possible without support from Médecins Sans Frontières.

The study authors concluded that a simplified HCV care model may be incorporated within a rural public health system in a low- or middle-income country with high efficacy and patient retention.

Reference

Zhang M, O’Keefe D, Craig J, et al. Decentralised hepatitis C testing and treatment in rural Cambodia: evaluation of a simplified service model integrated in an existing public health system. Lancet Gastroenterol Hepatol. 2021;6(5):371-380. doi:10.1016/S2468-1253(21)00012-1